Epilepsy Flashcards
What is epilepsy?
Umbrella term for condtion when there is a tendency to have seizures
What are seixures?
Abnormal electrical activity in brain
What is a generalised tonic-clonic seizures?
Loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) movements
What can be ass with a generalised tonic clonic seizure?
Tongue biting, incontinence, goraning, irregular breathing
What happens after a seizure?
Post ictal period
What happens in the post ictal period?
Confused, drowsy, feels irritable or low
Where do focal seizures start in the brain?
Temporal lobes
Tonic clonic vs focal seizure treat
Swap first and second line
1st - sodium valproate or levetriacetam
2nd - carbamazepine or lmaotrigine
How can focal seizures present?
- Hallucinations
- Memory flashbacks
- Déjà vu
- Doing strange things on autopilot
How long do absence seizures normally last?
10-20s
What can atonic seizures be indicative of?
Lennox-Gastaut syndrome
What is lennox-gastaut syndrome
‘epileptic and developmental encephalopathy’ because the epileptic seizures and the abnormal EEG are thought to be important in these childrens’ developmental delay and learning difficulties.
v severe
4 years
What is an atonic seizure?
Brief lapses in muscle tone
What do myoclonic seizures occur in children as a part of?
Juvenile myoclonic epilepsy
What is West syndrome?
Infantile spasms starting at around 6 months characterised by clusters of full body spasms
Prognosis of West syndrome
1/3 die by 25
1/3 seizure free
First line treatments for West syndomre
Preednisolone
Vigabatrin
What are febrile seizures caused by?
Fever
What age children do febrile seizures occur in?
6 months to 5 years
Outcome of febrile convjulsions
Good
1/3 will have another
Slight increased chance of developing epilepsy
Investigation for epilepsy
EEG - electroecnephalogram
When to use an EEG to investigate epilepsy?
After the second simple-tonic clonic seizure
When is an MRI considered for investigatiing seizures?
Child under 2 years when has first seizure
Focal seizures
No response to first line anti-epileptic medications
What additional investigations except brain imaging can be used to rule out seizure causes?
ECG
Blood electrolytes - Na, K, Ca, Mg
Blood glucose - hypo/diabetes
Blood cultures, urine cultures and lumbar puncture - sepsis, encephalitis or meningitis
What advise parents about with childs epilepsy?
Safety precautions
Recognising, managing and reporting seizures
Avoid situations where seizure may put child in danger
Dangerous situations for children with seizures
sHOWERS NOT BATHS
Cautious swimming unless close supervision and seizures well controlled
Cautious with:
heights
Traffic
Heavy, hot or electrical equipment
How do maintenance epileptic drugs work?
Raising seizure threshold and reducing liekelihood patient having a seizure
How does sodium valproate work?
Increase activity of GABA, relaxing effect on brain
Side effects of sodium valproate
Teratogenic
Liver damage and hepatitis
Hair loss
Tremor
Side effects of carbamazepine
Agranylocytosis
Aplastic anaemia
Induces P450 system
Phenytoin side effects
Folate and vitamin D deficinecy
Megoloblastic anaemia (folate deficiency)
Osteomalacia - vit D def
Ethosuximide side effects
Night terrors
Rashes
Lamotrigine side effects
Stevens-Johnson syndrome or DRESS synrome = life threatening skin rashes
Leukopenia
Management of seizures
- Put the patient in a safe position (e.g. on a carpeted floor)
- Place in the recovery position if possible
- Put something soft under their head to protect against head injury
- Remove obstacles that could lead to injury
- Make a note of the time at the start and end of the seizure
- Call an ambulance if lasting more than 5 minutes or this is their first seizure
What are epilepsy syndrome?
Typical age of onset
Specific seizure types and developmental antecedents/consequneces, physical exam
EEG and radiographic characteristics
Helps in pronosis but not a diagnosis
What is childhood absence epilepsy?
3-4 onset
Similar EEG and physical appearances
Treat for around 2 years
Normally grwo out of it
Epilepsy imitators
Syncope and anoxic seiaures
Behavioural psychological and psychiatric disorders
Examples of cynxope and anoxic seizures
Vasovagal syncope
Breath
Take history of seizure
Take history of seizure
What is febrile status epilepticus
Longer than 5 mins of seiuzreu
How old are children who get febrile seizures?
6 months to 5 years
Common infections causing febrile seizures
Viral infections
Tonsilitis
Otitis media
Gastroenteritis
Post immunisation
Why is it important to investigate febrile seizures under one?
Difficult to differentiate between meningitis and viral cause in under one years old
Serious causes of febrile illness in children
Meningitis
UTI
Chest infections
What to do after febrile seizure
Watch on ward
Blood tests
Urine tests
CSF if strong sus meningitis
When need to medicate febrile seziures
Staus epilepticus - over 5 mins
